P.A. Lemos Neto (Pedro)http://repub.eur.nl/ppl/795/
List of Publicationsenhttp://repub.eur.nl/eur_signature.pnghttp://repub.eur.nl/
RePub, Erasmus University RepositoryBioresorbable vascular scaffolds: Novel devices, novel interpretations, and novel interventions strategieshttp://repub.eur.nl/pub/52204/
Tue, 01 Jul 2014 00:00:01 GMT<div>C.A.M. Campos</div><div>P.A. Lemos Neto</div>
Predictive performance of SYNTAX score II in patients with left main and multivessel coronary artery disease - Analysis of CREDO-Kyoto registryhttp://repub.eur.nl/pub/67233/
Wed, 01 Jan 2014 00:00:01 GMT<div>C.A.M. Campos</div><div>D. van Klaveren</div><div>A. Iqbal</div><div>Y. Onuma</div><div>Y.-J. Zhang</div><div>H.M. Garcia-Garcia</div><div>M-A.M. Morel</div><div>V. Farooq</div><div>H. Shiomi</div><div>Y. Furukawa</div><div>Y. Nakagawa</div><div>K. Kadota</div><div>P.A. Lemos Neto</div><div>T. Kimura</div><div>E.W. Steyerberg</div><div>P.W.J.C. Serruys</div>
Bioresorbable drug-eluting magnesium-alloy scaffold for treatment of coronary artery diseasehttp://repub.eur.nl/pub/74907/
Mon, 16 Dec 2013 00:00:01 GMT<div>C.A.M. Campos</div><div>T. Muramatsu</div><div>A. Iqbal</div><div>Y.-J. Zhang</div><div>Y. Onuma</div><div>H.M. Garcia-Garcia</div><div>M. Haude</div><div>P.A. Lemos Neto</div><div>B. Warnack</div><div>P.W.J.C. Serruys</div>
The introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in treatment of coronary artery disease. However, this medical device can induce hypersensitive reaction that interferes with the endothelialization and healing process resulting in late persistent or acquired malapposition of the permanent metallic implant. Delayed endotheliaization and malapposition may lead to late and very late stent thrombosis. Bioresorbable scaffolds (BRS) have been introduced to potentially overcome these limitations, as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Magnesium is an essential mineral needed for a variety of physiological functions in the human body and its bioresorbable alloy has the strength-to-weight ratio comparable with that of strong aluminum alloys and alloy steels. The aim of this review is to present the new developments in Magnesium BRS technology, to describe its clinical application and to discuss the future prospects of this innovative therapy.Quantification of scientific output in cardiovascular medicine: A perspective based on global datahttp://repub.eur.nl/pub/61740/
Sun, 01 Dec 2013 00:00:01 GMT<div>G.A. Rodriguez-Granillo</div><div>A. Rodriguez</div><div>N. Bruining</div><div>J. Milei</div><div>J. Aoki</div><div>K. Tsuchida</div><div>R. del Valle-Fernández</div><div>C.A. Arampatzis</div><div>A.T.L. Ong</div><div>P.A. Lemos Neto</div><div>R. Ayala</div><div>H.M. Garcia-Garcia</div><div>F. Saia</div><div>M. Valgimigli</div><div>E.S. Regar</div><div>E. McFadden</div><div>G.G. Biondi-Zoccai</div><div>E. Barbenza</div><div>P. Schoenhagen</div><div>P.W.J.C. Serruys</div>
Aims: We sought to explore whether global and regional scientific output in cardiovascular medicine is associated with economic variables and follows the same trend as medicine and as science overall. Methods and results: We registered the number of documents, number of citations, citations per document and the h-index for the first 50 countries according to the h-index (a measure to evaluate both the productivity and impact of the publications) in cardiovascular medicine. Economic variables (gross domestic product [GDP] per capita, % expenditure of the GDP in research and development [R&D] and health) were obtained from the World Bank, the UNESCO, and the World Health Organization. In total, the scientific output in cardiology showed the same position as in medicine and science overall (mean difference vs. medicine -0.95.3°, p=0.25 vs. science -0.75.3°, p=0.39). We found significant correlations between the h-index and the % GDP expenditure in R&D (r=0.67, p0.001), and the % GDP expenditure in health (r=0.71, p0.0001). Overall, there was a 21.4% (interquartile range 3.7 55.0) increase in the % GDP expenditure in R&D between 1996 and 2007. Emerging economies showed the larger growth in % GDP expenditure in health and R&D. Conclusions: The global situation of scientific output in cardiovascular medicine is highly polarised and closely related to economic indicators. Emergent economies, with higher rates of GDP growth and increasingly larger expenditures for R&D and healthcare, are expected to show a visible escalation in the scientific global picture in the near future.Bioresorbable vascular scaffolds in the clinical settinghttp://repub.eur.nl/pub/71159/
Sun, 01 Dec 2013 00:00:01 GMT<div>C.A.M. Campos</div><div>Y. Zhang</div><div>C.V. Bourantas</div><div>T. Muramatsu</div><div>H.M. Garcia-Garcia</div><div>P.A. Lemos Neto</div><div>A. Iqbal</div><div>Y. Onuma</div><div>P.W.J.C. Serruys</div>
The introduction of metallic drug-eluting stents has reduced the risk of restenosis and widened the indications of percutaneous coronary intervention in coronary artery disease. However, the presence of a permanent metallic endoprosthesis to restore the patency of a stenotic artery has pitfalls, such as vascular inflammation, stent thrombosis and hindrance of the restoration of the physiologic function of the stented segment. Bioresorbable scaffolds were introduced to potentially overcome these limitations as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage. Currently, several bioresorbable scaffolds are available that are undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in bioresorbable scaffold technology, describe its clinical application and discuss the potential future prospects of this innovative therapy.Residual SYNTAX score for left main intervention: Are we really ready to predict the future?http://repub.eur.nl/pub/41452/
Sun, 01 Sep 2013 00:00:01 GMT<div>C.A.M. Campos</div><div>P.A. Lemos Neto</div>
Emerging technologies: Polymer-free phospholipid encapsulated sirolimus nanocarriers for the controlled release of drug from a stent-plus-balloon or a stand-alone balloon catheterhttp://repub.eur.nl/pub/74831/
Tue, 16 Jul 2013 00:00:01 GMT<div>P.A. Lemos Neto</div><div>V. Farooq</div><div>C.K. Takimura</div><div>P.S. Gutierrez</div><div>R. Virmani</div><div>F. Kolodgie</div><div>U. Christians</div><div>A.N. Kharlamov</div><div>M. Doshi</div><div>P. Sojitra</div><div>H.M.M. van Beusekom</div><div>P.W.J.C. Serruys</div>
Drug-eluting stents have proven to be effective in reducing the risk of late restenosis. In order to achieve a controlled and prolonged release of the antiproliferative agent, current drug-eluting stents utilise various biodegradable as well as non-erodible polymeric blends to coat the stent surface and to serve as drug carriers. The utilisation of polymeric compounds in current drug-eluting stents may eventually limit their performance as well as their clinical applicability due to the potential induction of undesirable local reactions. The development of alternative, polymer-free drug carriers has the potential to overcome some of the limitations of current drug-eluting stent formulations. Moreover, improvements in drug carriers may also result in an expansion of the technological possibilities for other intravascular drug delivery systems, such as metal-free or even implant-free solutions. This article describes the structure and the preclinical validation profile of a novel phospholipid encapsulated sirolimus nanocarrier, used as a coating in two formulations: a coronary stent-plus-balloon system and a stand-alone balloon catheter. The nanoparticles provided a stable, even and homogenous coating to the devices in both formulations. Dose-finding studies allowed the most appropriate identification of the best nanoparticle structure associated with an extremely efficient transfer of drug to all layers of the vessel wall, achieving high tissue concentrations that persisted days after the application, with low systemic drug leaks.A quantitative coronary angiography-matched comparison between a prospective randomised multicentre cutting balloon angioplasty and bare metal stent trial (REDUCE III) and the Rapamycin-Eluting Stent Evaluation at Rotterdam Cardiology Hospital (RESEARCH) studyhttp://repub.eur.nl/pub/74976/
Sun, 01 Aug 2010 00:00:01 GMT<div>Y. Ozaki</div><div>P.A. Lemos Neto</div><div>T. Yamaguchi</div><div>T. Suzuki</div><div>M. Nakamura</div><div>T.F. Ismail</div><div>M. Kitayama</div><div>H. Nishikawa</div><div>O. Kato</div><div>P.W.J.C. Serruys</div>
Aims: There remains significant concern about the long-term safety of drug-eluting stents (DES). However, bare metal stents (BMS) have been used safely for over two decades. There is therefore a pressing need to explore alternative strategies for reducing restenosis with BMS. This study was designed to examine whether IVUS-guided cutting balloon angioplasty (CBA) with BMS could convey similar restenosis rates to DES. Methods and results: In the randomised REstenosis reDUction by Cutting balloon angioplasty Evaluation (REDUCE III) study, 521 patients were divided into four groups based on device and IVUS use before BMS (IVUS-CBA-BMS: 137 patients; Angio-CBA-BMS: 123; IVUS-BA-BMS: 142; and Angio-BA-BMS: 119). At follow-up, the IVUS-CBA-BMS group had a significantly lower restenosis rate (6.6%) than the other groups (p=0.016). We performed a quantitative coronary angiography (QCA) based matched comparison between an IVUS-guided CBA-BMS strategy (REDUCE III) and a DES strategy (Rapamycin-Eluting-Stent Evaluation At Rotterdam Cardiology Hospital, the RESEARCH study). We matched the presence of diabetes, vessel size, and lesion severity by QCA. Restenosis (>50% diameter stenosis at follow-up) and target vessel revascularisation (TVR) were examined. QCA-matched comparison resulted in 120-paired lesions. While acute gain was significantly greater in IVUS-CBA-BMS than DES (1.65±0.41 mm vs. 1.28±0.57 mm, p=0.001), late loss was significantly less with DES than with IVUS-CBA-BMS (0.03±0.42 mm vs. 0.80±0.47 mm, p=0.001). However, no difference was found in restenosis rates (IVUS-CBA-BMS: 6.6% vs. DES: 5.0%, p=0.582) and TVR (6.6% and 6.6%, respectively). Conclusions: An IVUS-guided CBA-BMS strategy yielded restenosis rates similar to those achieved by DES and provided an effective alternative to the use of DES.Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease: A meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trialshttp://repub.eur.nl/pub/29131/
Tue, 09 Sep 2008 00:00:01 GMT<div>J. Daemen</div><div>H. Boersma</div><div>M. Flather</div><div>J. Booth</div><div>R.H. Stables</div><div>A. Rodriguez</div><div>G.A. Rodriguez-Granillo</div><div>W.A. Hueb</div><div>P.A. Lemos Neto</div><div>P.W.J.C. Serruys</div>
Background - Randomized trials that studied clinical outcomes after percutaneous coronary intervention (PCI) with bare metal stenting versus coronary artery bypass grafting (CABG) are underpowered to properly assess safety end points like death, stroke, and myocardial infarction. Pooling data from randomized controlled trials increases the statistical power and allows better assessment of the treatment effect in high-risk subgroups. Methods and Results - We performed a pooled analysis of 3051 patients in 4 randomized trials evaluating the relative safety and efficacy of PCI with stenting and CABG at 5 years for the treatment of multivessel coronary artery disease. The primary end point was the composite end point of death, stroke, or myocardial infarction. The secondary end point was the occurrence of major adverse cardiac and cerebrovascular accidents, death, stroke, myocardial infarction, and repeat revascularization. We tested for heterogeneities in treatment effect in patient subgroups. At 5 years, the cumulative incidence of death, myocardial infarction, and stroke was similar in patients randomized to PCI with stenting versus CABG (16.7% versus 16.9%, respectively; hazard ratio, 1.04, 95% confidence interval, 0.86 to 1.27; P=0.69). Repeat revascularization, however, occurred significantly more frequently after PCI than CABG (29.0% versus 7.9%, respectively; hazard ratio, 0.23; 95% confidence interval, 0.18 to 0.29; P<0.001). Major adverse cardiac and cerebrovascular events were significantly higher in the PCI than the CABG group (39.2% versus 23.0%, respectively; hazard ratio, 0.53; 95% confidence interval, 0.45 to 0.61; P<0.001). No heterogeneity of treatment effect was found in the subgroups, including diabetic patients and those presenting with 3-vessel disease. Conclusions - In this pooled analysis of 4 randomized trials, PCI with stenting was associated with a long-term safety profile similar to that of CABG. However, as a result of persistently lower repeat revascularization rates in the CABG patients, overall major adverse cardiac and cerebrovascular event rates were significantly lower in the CABG group at 5 years. Drug-eluting stents show delayed healing: Paclitaxel more pronounced than sirolimushttp://repub.eur.nl/pub/35822/
Sun, 01 Apr 2007 00:00:01 GMT<div>H.M.M. van Beusekom</div><div>F. Saia</div><div>J.D. Zindler</div><div>P.A. Lemos Neto</div><div>S.L.S.-T. Hoor</div><div>M.A.H. van Leeuwen</div><div>P.J. de Feijter</div><div>P.W.J.C. Serruys</div><div>W.J. van der Giessen</div>
Aims: To understand wound healing after drug-eluting stents (DES) placement in humans, we studied the histology of in-stent restenosis (ISR) tissue obtained by atherectomy from bare metal stents (BMS) and DES in comparison with de novo atherosclerosis. Methods and results: The tissue was retrieved from ISR in ten sirolimus-eluting stents (SES) and nine paclitaxel-eluting stents (PES), six BMS, and nine stenotic de novo atherosclerotic lesions and processed for histology and immunocytochemistry. Patients with ISR in PES showed a significantly higher incidence of unstable angina upon presentation for re-intervention (P = 0.046). De novo tissue tended to be more collagen rich, whereas ISR tissue tended to be more proteoglycan rich. In all groups, cell content consisted almost exclusively of smooth muscle cells. Histology showed that fibrinoid in ISR tissue was present only in DES (P = 0.004), as late as 2 years following DES placement, indicating a persistent incomplete healing response. The amount of fibrinoid, given as a percentage of total tissue in each atherectomy specimen, was greater in PES than in SES (17 vs. 5%, P = 0.026). Conclusion: ISR in DES shows incomplete neointimal healing as late as 2 years after implantation. Patients with ISR in PES presented with more unstable angina and showed more pronounced signs of delayed healing than SES. Cost-effectiveness of the unrestricted use of sirolimus-eluting stents vs. bare metal stents at 1 and 2-year follow-up: Results from the RESEARCH Registryhttp://repub.eur.nl/pub/65458/
Fri, 01 Dec 2006 00:00:01 GMT<div>A.T.L. Ong</div><div>J. Daemen</div><div>B.A. van Hout</div><div>P.A. Lemos Neto</div><div>J.L.H.R. Bosch</div><div>R.T. van Domburg</div><div>P.W.J.C. Serruys</div>
Aims: To assess the cost-effectiveness of sirolimus-eluting stents (SESs) compared with bare metal stents (BMSs) as the default strategy in unselected patients treated in the Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) Registry at 1 and 2-years following the procedure. Methods and results: A total of 508 consecutive patients with de novo lesions exclusively treated with SES were compared with 450 patients treated with BMS from the immediate preceding period. Resource use and costs of the index procedure, and clinical outcomes were prospectively recorded over a 2-year follow-up period. Follow-up costs were measured as unit costs per patient based on the incidence of clinically driven target vessel revascularization (TVR), to obtain cumulative costs at 1 and 2-years. Cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER) per TVR avoided. The use of SES cost €3036 more per patient at the index procedure, driven by the price of SES. Follow-up costs after 1-year were €1,089 less with SES when compared with BMS, due to less TVR, resulting in a net excess cost of €1968 per patient in the SES group, and reduced by a further €100 per patient in the second year. The incidence of death or myocardial infarction between groups was similar at 1 and 2 years. Rates of TVR in the SES and BMS groups were 3.7% vs. 10.4%, P<0.01 at 1 year, respectively; and 6.4% vs. 14.7%, P<0.001 at 2 years. The ICER per TVR avoided was €29 373 at 1 year, and €22 267 at 2 years. Conclusion: The use of SES, while significantly beneficial in reducing the need for repeat revascularization, was more expensive and not cost-effective in the RESEARCH registry at either 1 or 2-years when compared with BMS. On the basis of these results, in an unselected population with 1 year of follow-up, the unit price of SES would have to be €1023 in order to be cost-neutral.Higher intracoronary attenuation improves diagnostic accuracy in MDCT coronary angiography.http://repub.eur.nl/pub/57526/
Sun, 01 Oct 2006 00:00:01 GMT<div>F. Cademartiri</div><div>N.R.A. Mollet</div><div>P.A. Lemos Neto</div><div>F. Saia</div><div>M. Midiri</div><div>P.J. de Feyter</div><div>G.P. Krestin</div>
Risk factors for impaired health status differ in women and men treated with percutaneous coronary intervention in the drug-eluting stent erahttp://repub.eur.nl/pub/70624/
Sat, 01 Jul 2006 00:00:01 GMT<div>S.S. Pedersen</div><div>A.T.L. Ong</div><div>P.A. Lemos Neto</div><div>R.A.M. Erdman</div><div>P.W.J.C. Serruys</div><div>R.T. van Domburg</div>
Objectives: In patients treated with percutaneous coronary intervention (PCI) in the drug-eluting stent era, we compared women's and men's health status 6 and 12 months post-PCI and investigated whether predictors of poor health status at 12 months are similar for women and men. Methods: Consecutive patients (n=692; 28% women) treated with PCI completed the 36-item Short-Form Health Survey (SF-36) 6 and 12 months post-PCI. Results: There was a significant improvement in health status over time (P<.001), but women experienced a significantly poorer health status compared with men (P<.001) at 6 and 12 months, adjusting for differences in baseline characteristics and health status at 6 months. Predictors of impaired health status were generally different for women and men. In women, the predominant predictors were previous coronary artery bypass graft (CABG) surgery, renal impairment, and older age; in contrast, in men, older age was associated with better functioning. In women, previous CABG was associated with a 4-15 fold increased risk of impaired health status. Health status at 6 months was a predictor of all SF-36 domains at 12 months in both women and men. Conclusions: Women reported poorer health status compared with men 6 and 12 months post-PCI, and predictors of impaired health status generally differed for women and men. Further studies examining risk factors for adverse outcomes for women and men separately, which will lead to better risk stratification in research and clinical practice, are warranted.Sirolimus-eluting stents remain superior to bare-metal stents at two years: Medium-term results from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registryhttp://repub.eur.nl/pub/58241/
Fri, 07 Apr 2006 00:00:01 GMT<div>A.T.L. Ong</div><div>R.T. van Domburg</div><div>J. Aoki</div><div>K. Sonnenschein</div><div>P.A. Lemos Neto</div><div>P.W.J.C. Serruys</div>
OBJECTIVES: The purpose of this study was to investigate the medium-term (two year) outcome of the unrestricted utilization of sirolimus-eluting stents (SES) in an all-comer population. BACKGROUND: Despite the implantation of SES in over a million patients to date, limited data exist on long-term outcomes. METHODS: Sirolimus-eluting stents were used as the default strategy as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry. A total of 508 consecutive patients with de novo lesions exclusively treated with SES were compared with 450 patients who received bare stents in the immediately preceding period (pre-SES group). RESULTS: Patients in the SES group more frequently had multivessel disease, more type C lesions, received more stents, and had more bifurcation stenting. At two years, the cumulative rate of major adverse cardiac events (death, myocardial infarction, or target vessel revascularization) was 15.4% in the SES group and 22.0% in the pre-SES group (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.50 to 0.91; p = 0.01). The two-year risk of target vessel revascularization in the SES group and in the pre-SES group was 8.2% and 14.8%, respectively (HR 0.53, 95% CI 0.36 to 0.79; p = 0.002). CONCLUSIONS: In an unrestricted population, the beneficial effects of sirolimus-eluting stent implantation extend out to two years compared with bare-metal stents, driven by a reduction in re-intervention rates. These findings should be confirmed by the results of the large randomized trials.Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantationhttp://repub.eur.nl/pub/70802/
Sun, 01 Jan 2006 00:00:01 GMT<div>S.H. Hofma</div><div>W.J. van der Giessen</div><div>B.M. van Dalen</div><div>P.A. Lemos Neto</div><div>E.P. McFadden</div><div>G. Sianos</div><div>J.M.R. Ligthart</div><div>D. van Essen</div><div>P.J. de Feyter</div><div>P.W.J.C. Serruys</div>
Aims: Endothetial dysfunction has been related both to progression of atherosclerotic disease and to future cardiovascular events. We assessed local epicardial endothelial function 6 months after sirolimus-eluting stent (SES) or bare metal stent (BS) implantation. Methods and results: In 12 patients (seven SES, five BS), endothelium-dependent vasomotion of a coronary segment 15 mm in length, starting 2 mm distal to the stent, was assessed with quantitative coronary angiography immediately after the procedure and at 6 months follow-up, after intracoronary infusion of acetylcholine. Intravascular ultrasound (IVUS) was performed and coronary flow reserve (CFR) assessed in all patients. At follow-up significant vasoconstriction was seen in SES (median 32% diameter reduction from baseline) but not in BS (median 2% reduction) patients after acetylcholine infusion (P = 0.03 for SES vs. BS); endothelium-independent vasodilatation to nitrates did not differ significantly between groups (20% SES, 5% BS, P = 0.14). IVUS revealed no late unhealed dissections and CFR was comparable between groups (SES 3.1 vs. BS 3.2, n.s.). Conclusion: SES implantation may have an adverse effect on local endothelium-dependent vasomotor responses compared with BS implantation at 6 months. Long-term clinical consequences of this observation are still unknown.Usefulness of multislice computed tomographic coronary angiography to assess in-stent restenosishttp://repub.eur.nl/pub/54646/
Thu, 15 Sep 2005 00:00:01 GMT<div>F. Cademartiri</div><div>N.R.A. Mollet</div><div>P.A. Lemos Neto</div><div>F. Pugliese</div><div>T. Baks</div><div>E.P. McFadden</div><div>G.P. Krestin</div><div>P.J. de Feyter</div>
Fifty-one patients (42 men; 60 ± 12 years of age) who had previous stent implantation underwent multislice computed tomographic coronary angiography. All coronary branches <2.0 mm were independently evaluated by 2 observers and screened for in-stent restenosis (<50%) and occlusion. The consensus reading was compared with the quantitative coronary angiogram. Six of the 74 (8.1%) evaluated stents (3 restenoses and 3 occlusions) were significantly diseased. The sensitivity, specificity, and positive and negative predictive values to identify restenosis were 83.3% (95% confidence interval [CI] 35.9 to 99.6), 98.5% (95% CI 92.1 to 100), 83.3% (95% CI 35.9 to 99.6), and 97.3% (95% CI 92.1 to 100), respectively. One in-stent restenosis remained undetected.One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: A meta-analysis of individual patient data from randomized clinical trialshttp://repub.eur.nl/pub/54301/
Mon, 01 Aug 2005 00:00:01 GMT<div>N.F. Mercado</div><div>W. Wijns</div><div>P.W.J.C. Serruys</div><div>U. Sigwart</div><div>M. Flather</div><div>R.H. Stables</div><div>W.W. O'Neill</div><div>A. Rodriguez</div><div>P.A. Lemos Neto</div><div>W.A. Hueb</div><div>B.J. Gersh</div><div>J. Booth</div><div>H. Boersma</div>
Background: We aimed to provide a quantitative analysis of the 1-year clinical outcomes of patients with multisystem coronary artery disease who were included in recent randomized trials of percutaneous coronary intervention with multiple stenting versus coronary artery bypass graft surgery. Methods: An individual patient database was composed of 4 trials (Arterial Revascularization Therapies Study, Stent or Surgery Trial, Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease 2, and Medicine, Angioplasty, or Surgery Study 2) that compared percutaneous coronary intervention with multiple stenting (N = 1518) versus coronary artery bypass graft surgery (N = 1533). The primary clinical end point of this study was the combined incidence of death, myocardial infarction, and stroke at 1 year after randomization. Secondary combined end points included the incidence of repeat revascularization at 1 year. All analyses were based on the intention-to-treat principle. Results: After 1 year of follow-up, 8.7% of patients randomized to percutaneous coronary intervention with multiple stenting versus 9.1% of patients randomized to coronary artery bypass graft surgery reached the primary clinical end point (hazard ratio 0.95 and 95% confidence interval 0.74'1.2). Repeat revascularization procedures occurred more frequently in patients allocated to percutaneous coronary intervention with multiple stenting compared with coronary artery bypass graft surgery (18% vs 4.4%; hazard ratio 4.4 and 95% confidence interval 3.3'5.9). The percentage of patients who were free from angina was slightly lower after percutaneous coronary intervention with multiple stenting than after coronary artery bypass graft surgery (77% vs 82%; P = .002). Conclusions: One year after the initial procedure, percutaneous coronary intervention with multiple stenting and coronary artery bypass graft surgery provided a similar degree of protection against death, myocardial infarction, or stroke for patients with multisystem disease. Repeat revascularization procedures remain high after percutaneous coronary intervention, but the difference with coronary artery bypass graft surgery has narrowed in the era of stenting. CopyrightLong term outcome after intracoronary β radiation therapyhttp://repub.eur.nl/pub/56279/
Fri, 01 Jul 2005 00:00:01 GMT<div>G. Sianos</div><div>A. Hoye</div><div>F. Saia</div><div>W.J. van der Giessen</div><div>P.A. Lemos Neto</div><div>P.J. de Feyter</div><div>P.C. Levendag</div><div>R.T. van Domburg</div><div>P.W.J.C. Serruys</div>
Impact of coronary calcium score on diagnostic accuracy for the detection of significant coronary stenosis with multislice computed tomography angiographyhttp://repub.eur.nl/pub/57015/
Sun, 15 May 2005 00:00:01 GMT<div>F. Cademartiri</div><div>N.R.A. Mollet</div><div>P.A. Lemos Neto</div><div>F. Saia</div><div>G. Runza</div><div>M. Midiri</div><div>G.P. Krestin</div><div>P.J. de Feyter</div>
One hundred twenty patients in sinus rhythm with suspected coronary artery disease who underwent multislice computed tomography of the heart and conventional coronary angiography were retrospectively selected. The population was divided into 2 groups depending on their calcium score (CS) (e.g., low CS and high CS). The diagnostic accuracy of multislice computed tomographic scans for detecting significant lesions (>50% lumen reduction) in both groups was compared with quantitative coronary angiography. The sensitivity and specificity of multislice computed tomography were 90% and 92%, and 97% and 91% for low and high CS groups, respectively.Noninvasive assessment of coronary plaque burden using multislice computed tomographyhttp://repub.eur.nl/pub/58526/
Sun, 15 May 2005 00:00:01 GMT<div>N.R.A. Mollet</div><div>F. Cademartiri</div><div>K. Nieman</div><div>F. Saia</div><div>P.A. Lemos Neto</div><div>E.P. McFadden</div><div>P.W.J.C. Serruys</div><div>G.P. Krestin</div><div>P.J. de Feyter</div>
We performed coronary plaque imaging with 16-row multislice computed tomography in 85 patients who had stable angina pectoris and a high pretest likelihood of having coronary plaque to evaluate plaque burden, i.e., extent (number of diseased coronary segments) and size (small vs large) of plaque. We also assessed type of plaque (calcified, noncalcified, or mixed) and its anatomic distribution. Of 85 patients included, 78 (92%) had fully evaluable multislice computed tomograms that allowed assessment of coronary plaque burden, including major and side branches (≥2 mm), yielding a total of 855 segments. These 78 patients (92% men; mean age ± SD 58 ± 11.5 years) were in sinus rhythm, with heart rates of <70 beats/min (spontaneous or induced by β blocker). Plaque was detected in 57% of all segments (487 of 855). The mean number of segments with plaque per patient ± SD was 6.2 ± 3.9. Plaque was classified as large in 33% of segments and small in 67%. Overall, 65% of plaques were calcified, 24% were noncalcified, and 11% were mixed. Plaques were predominantly located in the proximal and middle segments of the main coronary vessels.